Recurrent shoulder dislocation

zvankleek1

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Okay here is the problem. The patient is a 14-year-old female who has had multiple anterior shoulder dislocations within a four-week time frame. All reduced by another physician in another hospital. My doc sees the patient in the emergency room for another dislocation. He takes her to surgery to reduce the shoulder. The shoulder reduces but when he sits her up it dislocates again. Since patient already has appointment for the next day with a shoulder surgeon in yet another city he halted further attempts at reduction and just placed her an immobilizer.

Question: I can bill for the reduction, but do I need to use a 53 modifier on this?

Any help would be appreciated.

Thanks,

Zoe
 

mbort

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since he completed the reduction, yes you can code for it (providing his documentation supports all of the above from your post). No modifier is necessary.
 

maudys

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modifier 53

i don't believe you can use modifier 53 simply because the procedure was completed and the complication happened after the fact. modifier 53 states "started but discontinued before completion due to the patient's condition".

if the procedure was completed, you do not need to reduce your service.
 

zvankleek1

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Thank you so much. I didnt think I needed to, but then you begin to second guess yourself. Have a great day to all.

Zoe:D
 
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Shoulder reduction twice

A pt is seen for a recurrent shoulder dislocation in the ER (8th one). The ERP reduces the dislocation, xray done, then shoulder dislocates again in the same setting. The ERP reduces again with some difficulty. Can we bill for the 2nd reduction?
 

MnTwins29

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Modifier -76

This sounds like the second reduction would need modifier -76 as well as supporting documentation why the procedure had to be repeated.
 
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